Health Equity Considerations For Virginia's African American Children
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Health Equity Considerations For Virginia's African American Children

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Health Equity Considerations for Virginia's African American Children: The Importance of Social Determinants of Health...

Health Equity Considerations for Virginia's African American Children: The Importance of Social Determinants of Health

Prepared by Cheza Garvin, PhD, MPH, MSW, Assistant Professor and Academic Director, Consortium for Infant and Child Health (CINCH). Presented by Keisha Cutler, MPH, Assistant Director, CINCH, Department of Pediatrics, Division of Community Health & Research, Eastern Virginia Medical School

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  • CINCH is a coalition of over 200 agencies and individuals working in partnership with the mission of engaging the community to improve children’s health in Hampton Roads. Founded in 1993, CINCH has initiated, coordinated and/or participated in several successful health initiatives, has received national recognition for its work and has a focus on policy and systems change rather than individual services.
  • Data are from various studies and surveillance sources, e.g. CDC, NIH, the Prevention Institute, census (2000), others.
  • But this talk is not really about the data. VDH does a good job of tracking data for the Commonwealth, although we are always looking for more regional data for Hampton Roads. I really want to talk more about impacts on children and efforts to create solutions.
  • Individual lifestyle change is an important component, but “….”. We must create a social/political/economic and physical environment in which people can readily make healthy lifestyle choices.
  • These determinants are important for the health of all groups, yet it is in these categories that African Americans are disproportionately subject to poor, inadequate or substandard conditions that are by and large beyond individual control. Societal infrastructure, i.e. policies, systems and environments must be improved to assure equity in these factors for our African American families. The GOOD NEWS is that more and more, these complex issues are being understood and gradually being incorporated into planning and policy development.
  • These determinants are important for the health of all groups, yet it is in these categories that African Americans are disproportionately subject to poor, inadequate or substandard conditions that are by and large beyond individual control. Societal infrastructure, i.e. policies, systems and environments must be improved to assure equity in these factors for our African American families. The GOOD NEWS is that more and more, these complex issues are being understood and gradually being incorporated into planning and policy development.
  • The social ecological model provides a theoretical “framework to examine the multiple effects and interrelatedness of social elements in an environment” and helps to define the multiple levels from which to view and seek solutions for societal problems. We need to work on all levels toward the same goals in order to improve health for everyone and to pay special attention to cultural impacts to reduce health disparities and inequities.
  • Similarly to the social ecological model, the spectrum of prevention illustrates multiple levels upon which actions can and should be taken to effect the primary prevention of health-related problems and conditions. It can be an approach to eliminating health disparities and inequities. Strengthening Individual Knowledge and Skills  Enhancing an individual's capability of preventing injury or illness and promoting safety Promoting Community Education  Reaching groups of people with information and resources to promote health and safety Educating Providers  Informing providers who will transmit skills and knowledge to others Fostering Coalitions and Networks  Bringing together groups and individuals for broader goals and greater impact Changing Organizational Practices Adopting regulations and shaping norms to improve health and safety Influencing Policy Legislation  Developing strategies to change laws and policies to influence outcomes
  • These are examples of common types of experiences of African American families in medical settings in these locations. What are the likely outcomes of these types of scenarios? What are some of the likely social determinants at play in these cases? Such as, economics/income, provider bias, access and quality of care issues. When you look beyond the medical setting to other community settings, other determinants of health, the issues grow exponentially.
  • The road to health equity may seem endless, but it doesn’t have to be lonely. I believe there is a light at the end of this long tunnel and many who will invest their time, energy and expertise toward creating a social/environmental infrastructure supportive of healthy communities and healthy people. Some examples of efforts follow.
  • These national programs either seek to establish best practices or are already putting evidence-based best practices to work, or both. I will only address a few of these. All are designed to be inclusive of African Americans and other communities of color, with specific, mandated focus from REACH, CCHE and Place Matters. CCHE and Champion have a mandated focus specifically on child health.
  • This slide provides examples following the spectrum of prevention using a social ecological model approach and incorporates some of the solutions suggested by the Prevention Institute.
  • Traditionally we think only of high level officials and decision makers – extremely important stakeholders who can make policy happen and pave the way for its implementation. What about community-based organizations? What about community residents? What about the children themselves? What about other non-traditional sectors? Is everyone heard? Does everyone understand what is happening? Who gets a vote? Who needs to buy in to assure successful implementation? Does everyone understand their value, their responsibility, their pride of participation? Ponder and plan how to engage people within the African American community so they can have a voice. Civic engagement beyond the voting booth….
  • Superimposed on a map of Virginia, these pictures illustrate what it might look like for African American children, adults and families to have a healthy environment sustained by strong policies, regulations and programs and where the health equity gap is eliminated. Such a community would ultimately be healthy for all Virginians of any race, ethnicity or cultural background.
  • We need to remember to celebrate our successes along the way. Incremental steps lead to big leaps over time.

Health Equity Considerations For Virginia's African American Children Health Equity Considerations For Virginia's African American Children Presentation Transcript

  • Prepared by Cheza Garvin, PhD, MPH, MSW Assistant Professor and Academic Director, Consortium for Infant and Child Health (CINCH) Presented by Keisha Cutler, MPH, Assistant Director, CINCH Department of Pediatrics, Division of Community Health & Research, Eastern Virginia Medical School
    • African American children and youth have higher* rates of….:
      • Poverty
      • Overweight/obesity (girls)
      • Injuries from violence (boys)
      • High school dropouts
      • Asthma (uncontrolled)
      • Infant mortality and low birth weight
    *Rates are usually in comparison to caucasian peers, sometimes to general population, income groups or other communities of color.
    • And higher risks of
      • Type II diabetes
      • Environmental toxin exposures
      • Adverse effects of exposure to tobacco smoke
    • And lower rates of
      • Academic achievement
      • Employment and income
      • Two-parent families
    • Etc.
    • Definitions from Virginia Department of Health:
      • “ Health equity is achieving the highest level of health for all people”
      • If health inequity derives from disparities that are systemic, avoidable, and unjust, then it is encumbent upon us to create and maintain a system that will prevent these inequities from occurring.
    • Why is this important?
    • “ A chain is only as strong as its weakest link”
      • Common sentiment expressed to encourage team building, what about building a healthy community?
      • Health equity cannot be achieved if any group is left out, marginalized, disenfranchised, if health status gaps are not closed….
  •  
    • Social Determinants underlie most health inequities
      • We tend to focus on health conditions: overweight/obesity, asthma, injuries, infant mortality, etc.
        • Lots of “bootstrap theory” for success, focusing only on individual behavior. This is important, but
      • We also need to focus on the world into which we are bringing our children – the social, economic and physical environment they face
    • Support community strengths, mitigate deficits
  •  
    • Health care access and quality
    • Economics/Income
    • Education and school/workforce preparedness
    • Employment/working conditions
    • Transportation: public, private, walking, biking, etc.
    • Exposure to toxins
    • Healthy food access: proximity, cost, quality
    • Healthy, walkable, built environment
    • Pollution-free (limited) environment
    • Freedom from discrimination/racism/unfair bias
    • Housing: construction, air quality, location, etc.
    • Safety (from crime and hazards)
    • Social integration and expression (belonging)
    • Civic engagement: having a say, community investment
  •  
  • Cohen & Swift, 1998
    • Asthma treatment for 12 year-old delayed due to high co-pay, inadequate health insurance (MD)
    • 14 year old girl assumed to be sexually active by clinic doctor, even though she had never been sexually active and resented the stereotype (DC)
    • Mother of toddler describes triage nurse as condescending and disrespectful, likely class and race-biased, refuses to return to that source of medical care (Hampton Roads, VA)
    • All African Americans, All with health impacts
    • Demographics
      • Population: 100,565; households: over 38,000; African American: 53%
      • 25,854 children, of whom 51% are below 200% of Federal Poverty Guidelines and 36% live in high poverty
      • 74% of school children are African American in public housing or neighborhoods with barriers to safe places to play and healthy eating
    • Food
      • Only 10 grocery stores, lots of corner stores with few fresh food options
      • One farmer’s market, downtown, once a month, summer only
    • Play and Fitness
      • One main public park with a children’s playground and athletic areas, 32 total parks, 15 with some play equipment
      • 8 recreation centers, most in disrepair and in high crime areas
    • Built Environment
      • Suburban design of “drivability”, not walkability
    • Health
      • High overweight (>65%), obesity (>29%) rates, not known for children yet
    • What does it mean for a low-income mother of three, without a car, to shop for healthy food when the grocery store is several miles away and takes three buses to get there? Meanwhile, the corner store is a two minute walk away and easy to get to after working all day.
    • If you see two children, ages 6 and 11, playing in the street in a neighborhood where the local gang members are known to harass and/or try to enlist kids, what do you feel?
  • Is that a mirage, or is it a light at the end of the tunnel? Long, lonely road ahead or are there many sources of expertise and support for these efforts?
    • CDC Initiatives
      • REACH (Racial and Ethnic Approaches to Community Health)
      • Steps to Health
      • ACHIEVE (Action Communities for Health, Innovation, and EnVironmental changE)
    • Robert Wood Johnson Foundation Initiatives
      • Active Living by Design (ALD)
      • Communities Creating Healthy Environments (CCHE)
    • W. K. Kellogg Foundation Initiatives
      • Place Matters
      • Food and Fitness
    • Other Federal Initiatives
      • Champion Program
      • Communities Putting Prevention to Work
    • Action Communities for Health, Innovation, and EnVironmental changE (ACHIEVE)
      • Bringing community leadership together to develop and implement policies that favorably impact health
    • Portsmouth ACHIEVEs
      • Recently awarded ACHIEVE community grant via CINCH from National Association of Chronic Disease Directors (NACDD)
    • Accomack County ACHIEVE
      • Recently awarded ACHIEVE community grant via the YMCA of Hampton Roads from YMCA-USA
    • Alexandria ACHIEVE
      • ACHIEVE award from previous year via health department from National Association of City and County Health Officials (NACCHO)
    • Unnatural Causes
      • Four hours of film from California Newsreel
      • Exploring policy, systems and environmental causes of health inequities
      • Community dialogues to raise awareness and prompt change
    • Place Matters
      • W. K. Kellogg Foundation funded national initiative coordinated by the Joint Center for Political and Economic Studies Health Policy Institute
      • Goal to eliminate health disparities by addressing social determinants of health
    • Champion
      • BodyWorks in Hampton Roads
      • Breastfeeding at Work
    • BMI Assessments
      • BMI 4Kidz
      • Obesity prevention in Portsmouth
    • ACHIEVE
      • Alexandria, Accomack and Portsmouth
    • Communities Putting Prevention to Work (CPPW)
      • Application pending for Accomack and Alexandria
    • Instill health and safety considerations into land use and planning decisions.
    • Improve safety and accessibility of public transportation, walking, and bicycling.
    • Enhance opportunities for physical activity.
    • Enhance availability of healthy products and reduce exposure to unhealthy products in underserved communities.
    • Increase housing quality, affordability, stability, and proximity to resources.
    • Improve air, water, and soil quality.
    • Prevent violence using a public health framework.
    • Provide high-quality, affordable health coverage for all.
    • Institute culturally and linguistically appropriate screening, counseling, and health care treatment.
    • Monitor health care models/procedures that are effective in reducing inequities in health and data documenting racial and ethnic differences in care outcomes.
    • Provide health care resources in the heart of the community and promote a Medical Home model.
    • Strengthen the diversity of the health care workforce to ensure that it is reflective and inclusive of the communities it is serving.
    • Establish sustainable funding mechanisms to support community health and prevention.
    • Collaborate with multiple fields to ensure that health, safety, and health equity are considered in every relevant decision, action, and policy.
    • Provide technical assistance and tools to support community-level efforts to address determinants of health and reduce inequities.
    • Tackle the inequitable distribution of power, money, and resources—the structural drivers of the conditions of daily life that contribute to inequitable health and safety outcomes—and especially address race, racism, and discrimination in institutions and polices; racial and socioeconomic segregation; and socioeconomic conditions.
    • Improve access to quality education and improve educational outcomes.
    • Invest in early childhood.
    • ACHIEVE
      • Opportunity to change city codes and enhance school and recreation regulations to promote healthy environments and prevent childhood smoking and exposure to tobacco smoke
    • BMI 4Kidz
      • Portsmouth Health Department purchased equipment to easily and non-intrusively collect body mass index (BMI) measures to help assess needs and guide overweight and obesity prevention interventions
      • Very few comprehensive approaches to tracking BMI in VA
    • Champion Body Works Program
      • Training the trainers to teach parents methods of promoting healthy food and physical activity for their children
    • Portsmouth YMCA Swim Gym
      • All second graders learn to swim – equipment and supplies provided
    • Call to Action for communities, organizations, government and electorate
    • Furthering Partnerships
    • Implementation of best practices
    • Working “upstream” to change policy (prevention) to avoid “downstream” patching of problems after they occur. This is systems change.
  • Would a round table be more inclusive, more inviting, more effective for communication? Who gets a vote? Civic engagement is more than the voting booth. Can community-based organizations be included? What about parents and children/youth?
  •  
  • Safe Routes to School in Walkable Built Environments Easy access to Healthy Food Options Equal access and support for high Educational Achievement Greater Economic Opportunity Physical Fitness for Life, Safe Play Places Elimination of Racism & Discrimination Full access to High Quality Health Care Ease of Transportation Housing (e)quality
  •